Are the determinants of the progression to type 2 diabetes and regression to normoglycemia in the populations with pre-diabetes the same?

Zeinab Alizadeh, Hamid Reza Baradaran* (Corresponding Author), Karim Kohansal, Farzad Hadaegh, Fereidoun Azizi, Davood Khalili* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)
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Background: We aimed to determine the predictors of regression to normoglycemia and progression to diabetes among subjects with pre-diabetes in a single model concurrently.

Methods: The present study included 1329 participants aged 20 to 70 years with prediabetes from the population-based cohort of the Tehran Lipid and Glucose Study, with a 10-year follow-up. Glycemic status at follow-up was categorized as regression to normoglycemia: fasting plasma glucose [FPG] of <5.55 and 2h-plasma glucose [PG] of <7.77 mmol/L, and not taking antidiabetic medications. Glycemic status at follow-up was categorized as progression to diabetes: FPG ≥7 or 2h-PG of ≥11.1 mmol/L, or taking antidiabetic medications. Glycemic status determined whether the patients remained in prediabetes category (isolated impaired fasting glycaemia [iIFG] [(5.55≤FPG<7 and 2h-PG<7.77 mmol/L); isolated impared glucose tolarence [iIGT] (7.77 ≤ 2h-PG<11.1 and FGP<5.55 mmol/L)]. With prediabetes as a reference, multinomial logistic regression was utilized to identify the determinants of glycemic changes.

Results: Approximately 40% of participants returned to normoglycemia (n = 578), and similar percentage of participants progressed to diabetes (n = 518). Based on the multivariable multinomial model, regression to normoglycemia was associated with age (relative risk ratio [RRR] = 0.97; 95% CI, 0.95-0.99), female sex (RRR = 1.72; 95% CI, 1.18-2.50), high education level of ≥12 years (RRR = 2.10; 95% CI, 1.19-3.70), and combined IFG/impaired glucose tolerance (IGT) versus IFG (RRR = 0.45; 95% CI, 0.29-0.70). The risk of progression to diabetes increased with body mass index (RRR = 1.10; 95% CI, 1.05-1.15), waist circumference (RRR = 0.97; 95% CI, 0.96-0.99), positive familial history of diabetes (RRR = 1.62; 95% CI, 1.07-2.45), and combined IFG/IGT versus IFG (RRR = 2.54; 95% CI, 1.71-3.77).

Conclusion: A small percentage of patients with prediabetes remain in this condition, but the majority go on to develop diabetes or regress to normoglycemia. Both directions had distinct predictors.

Original languageEnglish
Article number1041808
Number of pages10
JournalFrontiers in Endocrinology
Publication statusPublished - 7 Oct 2022

Bibliographical note

The main project has been funded by Shahid Beheshti University of Medical Sciences.

Data Availability Statement

The Supplementary Material for this article can be found online at:

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.


  • Humans
  • Female
  • Prediabetic State/epidemiology
  • Diabetes Mellitus, Type 2/epidemiology
  • Blood Glucose
  • Disease Progression
  • Iran/epidemiology
  • Glucose Intolerance/epidemiology
  • Hypoglycemic Agents
  • Lipids


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